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Golder JE, Bauer JD, Barker LA, Lemoh CN, Gibson SJ, Davidson ZE. Prevalence, risk factors, and clinical outcomes of vitamin C deficiency in adult hospitalized patients in high-income countries: a scoping review. Nutr Rev 2024; 82:1605-1621. [PMID: 38219216 PMCID: PMC11465154 DOI: 10.1093/nutrit/nuad157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2024] Open
Abstract
BACKGROUND Assessment for vitamin C deficiency (VCD) is rarely undertaken in an acute hospital setting in high-income countries. However, with growing interest in VCD in community settings, there is emerging evidence investigating the prevalence and impact of VCD during hospitalization. OBJECTIVES In this scoping review, the prevalence of VCD in adult hospitalized patients is explored, patient characteristics are described, and risk factors and clinical outcomes associated with VCD are identified. METHODS A systematic scoping review was conducted in accordance with the PRISMA-ScR framework. The Ovid MEDLINE, Ovid Embase, Scopus, CINAHL Plus, Allied and Complementary Medicine Database, and the Cochrane Library databases were searched for interventional, comparative, and case-series studies that met eligibility criteria, including adult hospital inpatients in high-income countries, as defined by the Organization for Economic Co-operation and Development, that reported VCD prevalence using World Health Organization reference standards. These standards define VCD deficiency as plasma or serum vitamin C level <11.4 µmol/L, wholeblood level <17 µmol/L, or leukocytes <57 nmol/108 cells. RESULTS Twenty-three articles were included, representing 22 studies. The cumulative prevalence of VCD was 27.7% (n = 2494; 95% confidence interval [CI], 21.3-34.0). High prevalence of VCD was observed in patients with severe acute illness and poor nutritional status. Scurvy was present in 48% to 62% of patients with VCD assessed in 2 studies (n = 71). Being retired (P = 0.015) and using excessive amounts of alcohol and tobacco (P = 0.0003) were independent risk factors for VCD (n = 184). Age was not conclusively associated with VCD (n = 631). Two studies examined nutrition associations (n = 309); results were inconsistent. Clinical outcomes for VCD included increased risk of frailty (adjusted odds ratio, 4.3; 95%CI, 1.33-13.86; P = 0.015) and cognitive impairment (adjusted odds ratio, 2.93; 95%CI, 1.05-8.19, P = 0.031) (n = 160). CONCLUSIONS VCD is a nutritional challenge facing the healthcare systems of high-income countries. Research focused on early identification and treatment of patients with VCD is warranted. SYSTEMATIC REVIEW REGISTRATION Open Science Framework ( https://doi.org/10.17605/OSF.IO/AJGHX ).
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Affiliation(s)
- Janet E Golder
- Department of Nutrition, Dietetics and Food, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
- Nutrition and Dietetics Department, Allied Health, Monash Health, Melbourne, Victoria, Australia
| | - Judith D Bauer
- Department of Nutrition, Dietetics and Food, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Lisa A Barker
- Department of Nutrition, Dietetics and Food, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Christopher N Lemoh
- Department of Medicine, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
- Department of Medicine, Western Health, Melbourne, Victoria, Australia
| | - Simone J Gibson
- School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Zoe E Davidson
- Department of Nutrition, Dietetics and Food, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
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2
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Visser J, Cederholm T, Philips L, Blaauw R. Prevalence and related assessment practices of adult hospital malnutrition in Africa: A scoping review. Clin Nutr ESPEN 2024; 63:121-132. [PMID: 38943652 DOI: 10.1016/j.clnesp.2024.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 05/15/2024] [Accepted: 06/13/2024] [Indexed: 07/01/2024]
Abstract
BACKGROUND AND AIMS Globally, hospital malnutrition prevalence is estimated at 20-50%, with little known about the situation in African hospitals. The aim of this scoping review was to appraise the current evidence base regarding the prevalence of adult hospital malnutrition and related assessment practices in an African context. METHODS A comprehensive and exhaustive search strategy was undertaken to search seven electronic bibliographic databases (including Africa-specific databases) from inception until August 2022 for articles/resources reporting on the prevalence of adult hospital malnutrition in an African setting. Two reviewers independently reviewed abstracts and full-text articles and data extraction was undertaken in duplicate. RESULTS We screened the titles and abstracts of 7537 records and included 28 studies. Most of the included studies were conducted in the East African region (n = 12), with ten studies from South Africa. Most studies were single-centre studies (n = 22; 79%), including 23 to 2126 participants across all studies. A variety of study populations were investigated with most described as medical and surgical populations (n = 14; 50%). Malnutrition risk prevalence was reported to be between 23% and 74%, using a variety of nutritional screening tools (including MNA-SF/LF, NRS-2002, MUST, NRI, GNRI). Malnutrition prevalence was reported to be between 8% and 85%, using a variety of tools and parameters, including ASPEN and ESPEN guidelines, SGA, MNA-SF/LF, anthropometric and biochemical indices, with one study using the GLIM criteria to diagnose malnutrition. CONCLUSIONS Both malnutrition risk and malnutrition prevalence are alarmingly high in African adult hospitalised patients. The prevalence of malnutrition differs significantly among studies, owing in part to the variety of tools used and variability in cut-offs for measurements, underscoring the importance of adopting a standardised approach. Realities in the African context include limited nutritional screening and assessment, poor referral practices, and a unique disease burden. General awareness is needed, and routine nutritional screening practices with appropriate nutrition support action should be implemented as a matter of urgency in African hospitals.
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Affiliation(s)
- Janicke Visser
- Division of Human Nutrition, Department of Global Health, Stellenbosch University, South Africa.
| | - Tommy Cederholm
- Clinical Nutrition and Metabolism, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | | | - Renée Blaauw
- Division of Human Nutrition, Department of Global Health, Stellenbosch University, South Africa
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3
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Viner Smith E, Kouw IWK, Summers MJ, Louis R, Chapman MJ, Chapple LAS. Evaluating physiological barriers to oral intake in hospitalized patients: A secondary analysis. JPEN J Parenter Enteral Nutr 2024; 48:833-840. [PMID: 39096187 DOI: 10.1002/jpen.2675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Revised: 07/09/2024] [Accepted: 07/15/2024] [Indexed: 08/05/2024]
Abstract
BACKGROUND Oral intake in hospitalized patients is frequently below estimated targets. Multiple physiological symptoms are proposed to impact oral intake, yet many have not been quantified objectively. AIM To describe the challenges of objectively measuring physiological nutrition-impacting symptoms in hospitalized patients. METHOD A secondary analysis of data from a single-center, descriptive cohort study of physiological nutrition-impacting symptoms in intensive care unit (ICU) survivors and general medical patients was conducted. Demographic and clinical characteristics were extracted for patients who completed the original study and collected retrospectively for those who were screened and recruited but did not complete the original study. Reasons for patient exclusion from the original study were quantified from the screening database. Descriptive data are reported as mean ± SD, median [interquartile range], or number (percentage). RESULTS ICU survivors and general medical patients were screened for inclusion in the original study between March 1 and December 23, 2021. Of the 644 patients screened, 97% did not complete the study, with 93% excluded at screening. Of the 266 ICU survivors and 398 general medical patients screened, 89% and 95% were excluded, respectively. Major exclusion criteria included the inability to follow commands or give informed consent (n = 155, 25%), the inability to consume the easy-to-chew and thin-fluid buffet meal, and imminent discharge (both, n = 120, 19%). CONCLUSION Understanding physiological factors that drive reduced oral intake in hospitalized patients is challenging. Exclusion criteria required to objectively quantify physiological nutrition-impacting symptoms significantly preclude participation and likely act as independent barriers to oral intake.
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Affiliation(s)
- Elizabeth Viner Smith
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
- Intensive Care Unit, Royal Adelaide Hospital, Adelaide, Australia
| | - Imre W K Kouw
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
- Intensive Care Unit, Royal Adelaide Hospital, Adelaide, Australia
- Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, Australia
| | - Matthew J Summers
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
- Intensive Care Unit, Royal Adelaide Hospital, Adelaide, Australia
| | - Rhea Louis
- Intensive Care Unit, Royal Adelaide Hospital, Adelaide, Australia
| | - Marianne J Chapman
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
- Intensive Care Unit, Royal Adelaide Hospital, Adelaide, Australia
- Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, Australia
| | - Lee-Anne S Chapple
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
- Intensive Care Unit, Royal Adelaide Hospital, Adelaide, Australia
- Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, Australia
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Meza-Valderrama D, Sánchez-Rodríguez D, Peña YC, Ramírez-Fuentes C, Muñoz-Redondo E, Morgado-Pérez A, Ortíz-Agurto N, Finis-Gallardo P, Marco E. Resistance Training and Nutritional Supplementation in Older Adults with Sarcopenia after Acute Disease: A Feasibility Study. Nutrients 2024; 16:3053. [PMID: 39339653 PMCID: PMC11434942 DOI: 10.3390/nu16183053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2024] [Revised: 08/14/2024] [Accepted: 08/15/2024] [Indexed: 09/30/2024] Open
Abstract
Resistance exercise and protein supplementation are recognized as effective treatment strategies for age-related sarcopenia; however, there are limited data on their feasibility, tolerability, and safety. The primary outcome of this study was feasibility, evaluated through the 15-item TELOS (Technological, Economics, Legal, Operational, and Scheduling) feasibility components and by recruitment, retention, and consent rates. Tolerability was measured by examining permanent treatment discontinuation, treatment interruption, exercise dose modification, early termination, rescheduling of missed sessions, losses to follow-up, attendance, and nutritional compliance. Safety was evaluated using the parameters provided by the European Medicines Agency, adapted for exercise interventions. Thirty-two subjects were recruited (average age 81.6 [SD 9.3] years). The TELOS components were assessed before the intervention; out of 15 questions relevant for successful implementation, 4 operational needs answers required specific actions to prevent potential barriers. The recruitment rate was 74%. Eleven patients (34.4%) had permanent treatment interruption (retention rate = 65.6%). Patients attended a mean of 23 (SD 12.0) exercise sessions, with a mean of 56 (SD 32.6) nutritional compliances. A total of 21 patients (65.6%) experienced adverse events unrelated to the intervention, while 7 patients (21.9%) presented adverse reactions to strength exercise. The main barriers to feasibility were operational components and recruitment challenges. Although the intervention was generally safe, the high rate of probable adverse effects, unrelated to the intervention but associated with the individual's baseline health condition, may affect adherence to treatment programs of this kind.
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Affiliation(s)
- Delky Meza-Valderrama
- Rehabilitation Research Group, Hospital del Mar Medical Research Institute, 08024 Barcelona, Catalonia, Spain
- Physical Medicine and Rehabilitation Department, National Institute of Physical Medicine and Rehabilitation, Panama City 0819, Panama
- Physical Medicine and Rehabilitation Center, Ciudad de la Salud, Caja de Seguro Social, Panama City 0819, Panama
- Sistema Nacional de Investigación (SENACYT), Panama City 0824, Panama
| | - Dolores Sánchez-Rodríguez
- Rehabilitation Research Group, Hospital del Mar Medical Research Institute, 08024 Barcelona, Catalonia, Spain
- Geriatrics Department, Brugmann University Hospital, Université Libre de Bruxelles, 1050 Brussels, Belgium
| | - Yulibeth Curbelo Peña
- Rehabilitation Research Group, Hospital del Mar Medical Research Institute, 08024 Barcelona, Catalonia, Spain
- Physical Medicine and Rehabilitation Department, Parc de Salut Mar (Hospital del Mar, Hospital de l'Esperança), 08024 Barcelona, Catalonia, Spain
| | - Cindry Ramírez-Fuentes
- Rehabilitation Research Group, Hospital del Mar Medical Research Institute, 08024 Barcelona, Catalonia, Spain
- Physical Medicine and Rehabilitation Department, Parc de Salut Mar (Hospital del Mar, Hospital de l'Esperança), 08024 Barcelona, Catalonia, Spain
| | - Elena Muñoz-Redondo
- Rehabilitation Research Group, Hospital del Mar Medical Research Institute, 08024 Barcelona, Catalonia, Spain
- Physical Medicine and Rehabilitation Department, Parc de Salut Mar (Hospital del Mar, Hospital de l'Esperança), 08024 Barcelona, Catalonia, Spain
| | - Andrea Morgado-Pérez
- Rehabilitation Research Group, Hospital del Mar Medical Research Institute, 08024 Barcelona, Catalonia, Spain
- Physical Medicine and Rehabilitation Department, Parc de Salut Mar (Hospital del Mar, Hospital de l'Esperança), 08024 Barcelona, Catalonia, Spain
| | - Norma Ortíz-Agurto
- Physical Medicine and Rehabilitation Department, National Institute of Physical Medicine and Rehabilitation, Panama City 0819, Panama
- Faculty of Health and Life Sciences, Metropolitan University of Education, Science and Technology (UMECIT), Panama City 0819, Panama
| | - Paola Finis-Gallardo
- Physical Medicine and Rehabilitation Department, National Institute of Physical Medicine and Rehabilitation, Panama City 0819, Panama
| | - Ester Marco
- Rehabilitation Research Group, Hospital del Mar Medical Research Institute, 08024 Barcelona, Catalonia, Spain
- Physical Medicine and Rehabilitation Department, Parc de Salut Mar (Hospital del Mar, Hospital de l'Esperança), 08024 Barcelona, Catalonia, Spain
- Faculty of Health and Life Sciences, Universitat Pompeu Fabra, Dr. Aiguader Building (Mar Campus), Dr. Aiguader 80, 08003 Barcelona, Catalonia, Spain
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5
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Chapman EN, Eastman A. Clinical progress note: Interventions for improving outcomes among hospitalized older adults. J Hosp Med 2024. [PMID: 39146053 DOI: 10.1002/jhm.13490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Revised: 08/01/2024] [Accepted: 08/03/2024] [Indexed: 08/17/2024]
Affiliation(s)
- Elizabeth N Chapman
- Geriatric Research Education and Clinical Center, William S. Middleton Memorial VA Medical Center, Madison, United States, United States
| | - Alexis Eastman
- Department of Medicine, Division of Geriatrics and Gerontology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
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Gvozdenović N, Šarac I, Ćorić A, Karan S, Nikolić S, Ždrale I, Milešević J. Impact of Vitamin D Status and Nutrition on the Occurrence of Long Bone Fractures Due to Falls in Elderly Subjects in the Vojvodina Region of Serbia. Nutrients 2024; 16:2702. [PMID: 39203838 PMCID: PMC11356805 DOI: 10.3390/nu16162702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2024] [Revised: 08/09/2024] [Accepted: 08/12/2024] [Indexed: 09/03/2024] Open
Abstract
Bone fractures are a significant public health issue among elderly subjects. This study examines the impact of diet and vitamin D status on the risk of long bone fractures due to falls in elderly subjects in Vojvodina, Serbia. Conducted at the University Clinical Center of Vojvodina in autumn/winter 2022-2023, the study included 210 subjects >65 years: 105 (F: 80/M: 15) with long bone fractures due to falls and 105 (F: 80/M: 15) controls. Groups were similar regarding age and BMI. Dietary intakes (by two 24-h recalls) and serum vitamin D levels were analyzed. The fracture group had a significantly lower median daily vitamin D intake (1.4 μg/day vs. 5.8 μg/day), intake of calcium, energy, proteins, fats, fibers, dairy products, eggs, fish, edible fats/oils, and a higher intake of sweets (p < 0.001 for all). Serum vitamin D levels were significantly lower in the fracture group (40.0 nmol/L vs. 76.0 nmol/L, p < 0.001). Logistic regression identified serum vitamin D as the most important protective factor against fractures, and ROC curve analysis indicated that serum vitamin D levels > 50.5 nmol/L decreased fracture risk. Nutritional improvements (increased intake of vitamin D and protein sources such as fish, eggs, and dairy), increased sun exposure, and routine vitamin D supplementation during winter are advised.
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Affiliation(s)
- Nemanja Gvozdenović
- Faculty of Medicine, University of Novi Sad, 21137 Novi Sad, Serbia; (N.G.); (A.Ć.); (S.K.); (S.N.); (I.Ž.)
- Clinic for Orthopedic Surgery and Traumatology, University Clinical Center of Vojvodina, 21137 Novi Sad, Serbia
| | - Ivana Šarac
- Center of Research Excellence in Nutrition and Metabolism, Institute for Medical Research, National Institute of Republic of Serbia, University of Belgrade, 11129 Belgrade, Serbia;
| | - Andrijana Ćorić
- Faculty of Medicine, University of Novi Sad, 21137 Novi Sad, Serbia; (N.G.); (A.Ć.); (S.K.); (S.N.); (I.Ž.)
| | - Saša Karan
- Faculty of Medicine, University of Novi Sad, 21137 Novi Sad, Serbia; (N.G.); (A.Ć.); (S.K.); (S.N.); (I.Ž.)
- Clinic for Orthopedic Surgery and Traumatology, University Clinical Center of Vojvodina, 21137 Novi Sad, Serbia
| | - Stanislava Nikolić
- Faculty of Medicine, University of Novi Sad, 21137 Novi Sad, Serbia; (N.G.); (A.Ć.); (S.K.); (S.N.); (I.Ž.)
- Center of Laboratory Medicine, University Clinical Center of Vojvodina, 21137 Novi Sad, Serbia
| | - Isidora Ždrale
- Faculty of Medicine, University of Novi Sad, 21137 Novi Sad, Serbia; (N.G.); (A.Ć.); (S.K.); (S.N.); (I.Ž.)
| | - Jelena Milešević
- Center of Research Excellence in Nutrition and Metabolism, Institute for Medical Research, National Institute of Republic of Serbia, University of Belgrade, 11129 Belgrade, Serbia;
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Veldhuijzen van Zanten D, Vantomme E, Ford K, Cahill L, Jin J, Keller H, Nasser R, Lagendyk L, Strickland T, MacDonald B, Boudreau S, Gramlich L. Physician Perspectives on Malnutrition Screening, Diagnosis, and Management: A Qualitative Analysis. Nutrients 2024; 16:2215. [PMID: 39064658 PMCID: PMC11279970 DOI: 10.3390/nu16142215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2024] [Revised: 06/24/2024] [Accepted: 06/25/2024] [Indexed: 07/28/2024] Open
Abstract
Malnutrition is an important clinical entity that is frequently underdiagnosed and undertreated, in part due to a lack of education and different perceptions by healthcare providers on its value in medical practice. Given this void, the purpose of this qualitative study was to explore physicians' clinical perspectives on malnutrition care, including its prevalence in their practice, and potential barriers that might preclude the delivery of malnutrition care. Using a directed content qualitative analysis approach, a total of 22 general and subspecialist physicians across three Canadian provinces were interviewed using a series of standardized questions developed by a multidisciplinary research team. Responses were transcribed and then analyzed using NVivo Version 14 software. While physicians recognized the importance of malnutrition screening and treatment, they did not view themselves as the primary drivers and often deferred this responsibility to dietitians. Lack of standard malnutrition screening, education amongst allied healthcare providers, time, personnel, and referral processes to have patients assessed and managed for malnutrition were also identified as contributing factors. For physicians, malnutrition education, standard malnutrition screening during patient encounters, and access to the necessary tools to manage malnutrition using a more centralized approach and standard referral process were viewed as strategies with the potential to improve the ability of the physician to identify and manage disease-related malnutrition and its negative consequences.
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Affiliation(s)
| | - Erik Vantomme
- Department of Medicine, University of Saskatchewan, Regina, SK S4P 2H8, Canada
| | - Katherine Ford
- Department of Kinesiology & Health Sciences, University of Waterloo, Waterloo, ON N2L 3G1, Canada
| | - Leah Cahill
- Department of Medicine, Dalhousie University, Halifax, NS B3J 1V7, Canada
| | - Jennifer Jin
- Department of Medicine, Division of Gastroenterology, University of Alberta, Edmonton, AB T6G 2R3, Canada
| | - Heather Keller
- Department of Kinesiology & Health Sciences, University of Waterloo, Waterloo, ON N2L 3G1, Canada
| | - Roseann Nasser
- Saskatchewan Health Authority, Regina, SK S4P 1C4, Canada
| | | | | | | | - Sonya Boudreau
- Nova Scotia Health Authority, Halifax, NS B3H 2E1, Canada
| | - Leah Gramlich
- Department of Medicine, Division of Gastroenterology, University of Alberta, Edmonton, AB T6G 2R3, Canada
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Polański J, Tański W, Dudek K, Jankowska-Polańska B. Pain and Coping Strategies as Determinants of Malnutrition Risk in Lung Cancer Patients: A Cross-Sectional Study. Nutrients 2024; 16:2193. [PMID: 39064636 PMCID: PMC11279586 DOI: 10.3390/nu16142193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2024] [Revised: 07/05/2024] [Accepted: 07/08/2024] [Indexed: 07/28/2024] Open
Abstract
Progressive cachexia and malnutrition severely impact the physical and mental condition of cancer patients. Pain is a prognostic factor for shorter survival in cancer patients, and coping strategies are crucial for adapting to treatment and dietary regimens. This study assessed pain levels, pain-related beliefs, and coping strategies as factors increasing malnutrition risk in 257 lung cancer patients. Sociodemographic and clinical data were collected from medical records. The Mini Nutritional Assessment (MNA), Visual Analog Scale (VAS), Beliefs about Pain Control Questionnaire (BPCQ), and Coping Strategies Questionnaire (CSQ) were used. Overall, 42.8% of patients were at risk of malnutrition, and 17.5% were malnourished. Nutritional status negatively correlated with CSQ domains: reinterpretation of pain (RP: rho = -0.194; p = 0.002), catastrophizing (CP: rho = -0.414; p = 0.001), ignoring pain (IP: rho = -0.198; p = 0.001), praying/hoping (PH: rho = -0.253; p < 0.001), and coping self-statements (CS: rho = -0.172; p = 0.006); and BPCQ domains: the power of doctors (PD: rho = -0.196; p = 0.002) and VAS (rho = -0.451; p < 0.001). Nutritional status positively correlated with CSQ domains: pain control (PC: rho = 0.499; p < 0.001) and the ability to reduce pain (AR: rho = 0.512; p < 0.001). In multivariate regression analysis, a better nutritional status was associated with a younger age (β = -0.094; p < 0.001), non-small-cell lung cancer (NSCLC) (β = 1.218; p = 0.037), a greater ability to reduce pain (CSQ-AR) (β = 0.901; p < 0.001), lower catastrophizing (CSQ-CP) (β = -0.165; p = 0.001), and lower pain perceived (VAS) (β = 0.639; p < 0.001). Statistical analyses included Spearman's correlation and multivariate regression with a significance level of p < 0.05. Patients with a normal nutritional status had reduced doctor involvement in pain control, less frequent negative coping strategies, and more common positive coping strategies. A normal nutritional status correlates with lower perceived pain. A better nutritional status is linked to a younger age, NSCLC, lower pain levels, greater pain reduction ability, and lower scores in pain catastrophizing.
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Affiliation(s)
- Jacek Polański
- Department of Internal and Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, 50-556 Wrocław, Poland
| | - Wojciech Tański
- Faculty of Medicine, Wrocław University of Science and Technology, 50-376 Wrocław, Poland; (W.T.); (B.J.-P.)
- Department of Internal Medicine, 4th Military Clinical Hospital, 50-981 Wrocław, Poland
| | - Krzysztof Dudek
- Faculty of Mechanical Engineering, Wroclaw University of Science and Technology, 50-370 Wrocław, Poland;
| | - Beata Jankowska-Polańska
- Faculty of Medicine, Wrocław University of Science and Technology, 50-376 Wrocław, Poland; (W.T.); (B.J.-P.)
- Centre for Research and Innovation, 4th Military Clinical Hospital, 50-981 Wrocław, Poland
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Bhasin A, Huang L, Shieh MS, Pekow P, Lindenauer PK, Lagu T. Malnutrition in hospitalized adults in the United States, 2016-2019. J Hosp Med 2024. [PMID: 38982534 DOI: 10.1002/jhm.13456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 06/24/2024] [Accepted: 06/24/2024] [Indexed: 07/11/2024]
Abstract
BACKGROUND Malnutrition in hospitalized patients is associated increased length of stay, cost, readmission, and death. No recent studies have examined trends in prevalence or outcomes of hospitalized patients with a diagnosis of malnutrition. OBJECTIVES To study the prevalence of malnutrition diagnostic codes and associated hospital outcomes in the United States between 2016 and 2019. METHODS We conducted a retrospective trends study to identify use of malnutrition codes in hospitalizations in the National Inpatient Sample between 2016 and 2019. We used direct standardization by logistic regression to adjust outcomes of percutaneous gastrostomy tube placement, mechanical ventilation, and death for age, Gagne comorbidity score, and sex. We then used linear regression to test for trends over time by malnutrition type. RESULTS Across all hospitalizations, codes for diagnoses of non-severe malnutrition and severe malnutrition were present in 3.7% and 4.1% of hospitalizations, respectively. Codes for any malnutrition increased over time, from 6.6% in 2016 to 8.6% in 2018 (p = .03). Codes for severe malnutrition increased from 3.3% to 4.7% (p = .01). Among hospitalizations with coded severe malnutrition diagnoses, there was a statistically significant decrease in adjusted rate of death over time (-0.54% per year, p = .03) which was not seen in hospitalizations without coded malnutrition diagnoses. CONCLUSIONS Use of malnutrition diagnosis codes increased significantly from 2016 to 2019. During this time, mortality among hospitalizations with a diagnosis code for severe malnutrition decreased. Though the increased prevalence of malnutrition codes may represent a change in the clinical characteristics of hospitalized patients, the decline in mortality suggests some of the increase may be due to lower threshold for coding and assignment of the diagnosis to less ill patients.
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Affiliation(s)
- Ajay Bhasin
- Department of Medicine, Division of Hospital Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Department of Pediatrics, Division of Hospital-Based Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Lynn Huang
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Department Center for Health Services and Outcomes Research, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Meng-Shoiu Shieh
- Department of Healthcare Delivery and Population Sciences, University of Massachusetts Chan Medical School - Baystate, Springfield, Massachusetts, USA
- Department of Medicine, University of Massachusetts Chan Medical School - Baystate, Springfield, Massachusetts, USA
| | - Penelope Pekow
- Department of Healthcare Delivery and Population Sciences, University of Massachusetts Chan Medical School - Baystate, Springfield, Massachusetts, USA
- Department of Medicine, University of Massachusetts Chan Medical School - Baystate, Springfield, Massachusetts, USA
| | - Peter K Lindenauer
- Department of Healthcare Delivery and Population Sciences, University of Massachusetts Chan Medical School - Baystate, Springfield, Massachusetts, USA
- Department of Medicine, University of Massachusetts Chan Medical School - Baystate, Springfield, Massachusetts, USA
| | - Tara Lagu
- Department of Medicine, Division of Hospital Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Department Center for Health Services and Outcomes Research, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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10
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Fulbrook P, Lovegrove J, Ven S, Schnaak S, Nowicki T. Use of a risk-based intervention bundle to prescribe and implement interventions to prevent pressure injury: An observational study. J Adv Nurs 2024. [PMID: 38969344 DOI: 10.1111/jan.16309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 06/12/2024] [Accepted: 06/15/2024] [Indexed: 07/07/2024]
Abstract
AIM To explore the relationship between the prescription and implementation of pressure injury preventative interventions following risk assessment combined with a risk-stratified intervention bundle. DESIGN Single-centre, cross-sectional, observational, prospective. METHODS The charts and bedsides of 341 adult inpatients were examined. Data collection included pressure injury risk level, prescribed preventative interventions and evidence of intervention implementation. RESULTS Most patients (68.6%) were at risk of pressure injury, and most interventions were prescribed according to their risk level. However, evidence from direct observation and/or documentation indicated intervention implementation rates were relatively poor. Of nine interventions mandated for all patients, compliance with three patient-/carer-focused interventions was particularly poor, with evidence indicating they had been implemented for 3%-10% of patients. Also, nutritional screening-related interventions were implemented poorly. Clinically indicated implementation of heel-elevation devices and bariatric equipment was low for at-risk patients, and the implementation of interventions for patients with existing pressure injuries was suboptimal. Significant proportions of several interventions that were observed as having been implemented were not documented as such. CONCLUSION While most interventions were prescribed according to patient risk level, the overall implementation of interventions was poor. However, the results may in part be due to failure to document interventions as opposed to omitting them. IMPLICATIONS FOR PATIENT CARE Documentation of interventions is crucial as it provides evidence of the care provided. An increased focus on documentation of pressure injury preventative interventions is required, with a clear distinction between prescription and implementation. IMPACT The results highlighted several deficiencies in care, particularly relating to evidence of implementation, patient involvement and nutritional screening. The results from this study will be used to inform and improve future pressure injury prevention practice within the study hospital and should be used to inform and benchmark pressure injury preventative practices in other hospitals. REPORTING METHOD The study adheres to STROBE guidelines. PATIENT OR PUBLIC CONTRIBUTION None.
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Affiliation(s)
- Paul Fulbrook
- School of Nursing, Midwifery and Paramedicine, Faculty of Health Sciences, Australian Catholic University, Brisbane, Queensland, Australia
- Nursing Research and Practice Development Centre, The Prince Charles Hospital, Brisbane, Queensland, Australia
- School of Therapeutic Sciences, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Josephine Lovegrove
- Nursing Research and Practice Development Centre, The Prince Charles Hospital, Brisbane, Queensland, Australia
- National Health and Medical Research Council Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
- School of Nursing, Midwifery & Social Work, Faculty of Health and Behavioural Sciences, The University of Queensland, Herston, Queensland, Australia
| | - Saroeun Ven
- School of Nursing, Midwifery and Paramedicine, Faculty of Health Sciences, Australian Catholic University, Brisbane, Queensland, Australia
- Nursing Research and Practice Development Centre, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Sarah Schnaak
- Quality and Effectiveness Support Team, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Tracy Nowicki
- Quality and Effectiveness Support Team, The Prince Charles Hospital, Brisbane, Queensland, Australia
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11
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Cimoli M, Gibney J, Lim M, Castles J, Dammert P. Nil per os in the management of oropharyngeal dysphagia-exploring the unintended consequences. FRONTIERS IN REHABILITATION SCIENCES 2024; 5:1410023. [PMID: 38957683 PMCID: PMC11217566 DOI: 10.3389/fresc.2024.1410023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Accepted: 06/04/2024] [Indexed: 07/04/2024]
Abstract
Nil per os (NPO), also referred to as Nil by Mouth (NBM), is a health-related intervention of withholding food and fluids. When implemented in the context of a person with dysphagia, NPO aims to mitigate risks of aspiration. However, evidence demonstrating that NPO is beneficial as an intervention for people with dysphagia is lacking. This paper explores the theoretical and empirical evidence relating to the potential benefits and adverse effects of NPO and asserts that NPO is not a benign intervention. This paper argues for applying an ethics framework when making decisions relating to the use of NPO as an intervention for dysphagia, in particular addressing informed consent and a person's right to self-determination.
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Affiliation(s)
- Michelle Cimoli
- Speech PathologyDepartment, Allied Health Division, Austin Health, Heidelberg, VIC, Australia
| | - Jennifer Gibney
- Speech Pathology Department, Nepean Hospital, Penrith, NSW, Australia
| | - Mathew Lim
- Dental Services, Alfred Health, Prahran, VIC, Australia
- Melbourne Dental School, University of Melbourne, Carlton, VIC, Australia
| | - Jo Castles
- Speech PathologyDepartment, Allied Health Division, Austin Health, Heidelberg, VIC, Australia
| | - Pedro Dammert
- Pulmonary and Critical Care Department, Scripps Mercy Hospital Chula Vista, Chula Vista, CA, United States
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12
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Alvarez-Altamirano K, Bejarano-Rosales MP, González-Rodríguez BK, Mondragón-Nieto G, Alatriste-Ortiz G, Noguez LJJ, Gutiérrez-Salmeán G, Fuchs-Tarlovsky V. Prevalence of nutritional risk and malnutrition in hospitalized patients: a retrospective, cross-sectional study of single-day screening. Appl Physiol Nutr Metab 2024; 49:838-843. [PMID: 38700079 DOI: 10.1139/apnm-2023-0190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2024]
Abstract
Hospital malnutrition remains a significant public health issue, particularly in developing countries. The Global Leadership Initiative on Malnutrition (GLIM) proposed homogenizing criteria to standardize malnutrition diagnosis. This study aimed to retrospectively determine the prevalence of nutritional risk and malnutrition diagnoses among hospitalized patients using the Nutritional Risk Screening (NRS)-2002 screening instrument and the GLIM criteria, respectively. We conducted a retrospective, cross-sectional study from nutritional records of patients hospitalized in a single centre 2021. Nutrition data from records included medical diagnosis, gender, length of stay, age, weight, height, body mass index, weight loss, calf circumference, and middle upper arm circumference. Nutritional risk and malnutrition were evaluated using NRS-2002 and GLIM criteria. Its concordance was further evaluated by using a Kappa test. The study included 616 records of patients; 52.3% (n = 322) of the population were male. The prevalence of nutritional risk, according to NRS-2002, was 69.5% (n = 428). Nutritional risk as well as malnutrition diagnosis according to GLIM criteria was observed in 87.8% (n = 374) of patienttritional risk and malnutrition were evaluated using NRS-2002 and GLIM criteria. Its concordance was further evaluated by using a Kappa test. Ws. Tools showed a strong concordance (κ= 0.732). All anthropometric data, except for height, were found to be significantly different between patients with moderate and severe malnutrition (p < 0.05). Our findings highlight a high prevalence of malnutrition in this group of hospitalized patients in Mexico. NRS-2002 demonstrated good agreement with the diagnosis of malnutrition according to GLIM criteria and could be considered part of the straightforward two-step approach for malnutrition; however, further studies are needed.
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Affiliation(s)
| | | | | | | | | | - Liz J Jiménez Noguez
- Clinical Nutrition, Hospital General de México, Dr. Eduardo Liceaga. Mexico City, México
| | - Gabriela Gutiérrez-Salmeán
- Health Sciences Research Center (CICSA), Faculty of Health Sciences, Universidad Anáhuac México, Mexico City, Mexico
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13
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Roberts S, Nucera R, Dowd T, Turner K, Langston K, Keller H, Bell J, Angus RL. Prospective validation of the Global Leadership Initiative on Malnutrition criteria for identifying malnutrition in hospitals: A protocol and feasibility pilot study. Nutr Clin Pract 2024. [PMID: 38711239 DOI: 10.1002/ncp.11156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 04/03/2024] [Accepted: 04/07/2024] [Indexed: 05/08/2024] Open
Abstract
BACKGROUND The aim of this study was to pilot a protocol for prospective validation of the Global Leadership Initiative on Malnutrition (GLIM) criteria in hospital patients and evaluate its feasibility and patient acceptability. METHODS The validation protocol follows the GLIM consortium's rigorous methodological guidance. Protocol feasibility was assessed against criteria on recruitment (≥50%) and data collection completion (≥80%); protocol acceptability was assessed via patient satisfaction surveys and interviews. Adult inpatients in a tertiary hospital underwent four nutrition assessments (each by a different assessor); two Subjective Global Assessments (SGAs) and two GLIM assessments. All five GLIM criteria were assessed with bioelectrical impedance analysis used for muscle mass. Interrater reliability, criterion validity, and predictive validity were reported to detect trends. RESULTS All primary feasibility criteria were met (consent rate 76%; data for GLIM criterion validity collected on 83% participants). Of predictive outcome data, 100% of hospital-related data, 82% of 6-month mortality data, and 39% of 6-month health-related quality of life data were collected. The mean (SD) age of participants was 61.0 ± 16.2 years, and 51.5% were male. The median (interquartile range) length of stay and body mass index were 7 (4-15) days and 25.6 (24.2-33.0) kg/m2, respectively. GLIM criteria diagnosed 70% of the patients as malnourished vs 55% with SGA. Most patients found the data collection acceptable with minimal burden. CONCLUSION The methods outlined in this rigorous GLIM validation protocol are feasible to undertake in hospitals and acceptable to patients. This paper provides practical methodological guidance for future prospective GLIM validation studies.
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Affiliation(s)
- Shelley Roberts
- School of Health Sciences and Social Work, Griffith University, Gold Coast Campus, Southport, Queensland, Australia
- Allied Health Research, Gold Coast Hospital and Health Service, Southport, Queensland, Australia
| | - Romina Nucera
- Nutrition and Food Services, Gold Coast Hospital and Health Service, Southport, Queensland, Australia
| | - Tobias Dowd
- School of Health Sciences and Social Work, Griffith University, Gold Coast Campus, Southport, Queensland, Australia
| | - Kyleigh Turner
- School of Health Sciences and Social Work, Griffith University, Gold Coast Campus, Southport, Queensland, Australia
| | - Keanne Langston
- Nutrition and Food Services, Gold Coast Hospital and Health Service, Southport, Queensland, Australia
| | - Heather Keller
- Schlegel-UW Research Institute for Aging, University of Waterloo, Ontario, Canada
- Department of Kinesiology and Health Sciences, University of Waterloo, Ontario, Canada
| | - Jack Bell
- Allied Health, The Prince Charles Hospital, Metro North Healthcare, Chermside, Queensland, Australia
| | - Rebecca L Angus
- Allied Health Research, Gold Coast Hospital and Health Service, Southport, Queensland, Australia
- Nutrition and Food Services, Gold Coast Hospital and Health Service, Southport, Queensland, Australia
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14
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Hansen MC, Uhrenfeldt L, Ingstad K, Pedersen PU. Educational nutritional intervention to prevent loss of health-related quality of life among older adults after a surgical treatment: design of a randomised controlled trial. Trials 2024; 25:262. [PMID: 38622729 PMCID: PMC11017647 DOI: 10.1186/s13063-024-08096-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 04/09/2024] [Indexed: 04/17/2024] Open
Abstract
BACKGROUND Disease-related malnutrition after a hospital stay has major consequences for older adults, the healthcare system and society. This study aims to develop and test the effectiveness of an educational video to prevent loss of health-related quality of life among live-at-home older adults after surgical treatment in a hospital. METHOD This randomised controlled trial will occur at a regional hospital in Norway. Participants will be live-at-home adults aged 65 years and older. They will be recruited from three different surgical departments after a surgical procedure. Individuals with a body mass index below 24 and a home address in one of nine selected municipalities will be eligible for inclusion. Participants will be randomly assigned to either the intervention group or the control group. Those assigned to the intervention group will obtain access to a 6-min educational video 5 days after being discharged from the hospital. The control group will not obtain access to the video. The primary outcome will be health-related quality of life using the Norwegian Rand 36-Item Short Form Health Survey. Furthermore, we will measure body composition, number of readmissions and nutritional knowledge at inclusion and 3-month follow-up. DISCUSSION This randomised controlled trial is expected to provide insight into whether an educational video can improve the nutritional status of older adults following a surgical procedure and discharge from the hospital. The findings will be useful for assessing how videos offering nutritional advice to older adults who have undergone a surgical procedure can improve their health-related quality of life, reduce loss of function, prevent readmission to hospital and reduce healthcare costs. TRIAL REGISTRATION ClinicalTrials.gov NCT05950373. Registered on 11 July 2023.
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Affiliation(s)
| | - Lisbeth Uhrenfeldt
- Institute for Regional Health Research, Southern Danish University, Ortopedic dep., Lillebaelt University Hospital, Odense, Denmark
| | - Kari Ingstad
- Faculty of Nursing and Health Sciences, Nord University, Levanger, Norway
| | - Preben U Pedersen
- Department of Clinical Medicine, Centre of Clinical Guidelines, Aalborg University, Aalborg, Denmark
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15
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Roberts S, Marshall AP, Bromiley L, Hopper Z, Byrnes J, Ball L, Collins PF, Kelly J. Patient-Led, Technology-Assisted Malnutrition Risk Screening in Hospital: A Feasibility Study. Nutrients 2024; 16:1139. [PMID: 38674830 PMCID: PMC11055004 DOI: 10.3390/nu16081139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 03/29/2024] [Accepted: 04/09/2024] [Indexed: 04/28/2024] Open
Abstract
Malnutrition risk screening is crucial to identify at-risk patients in hospitals; however, screening rates can be suboptimal. This study evaluated the feasibility, acceptability, and potential cost-effectiveness of patient-led, technology-assisted malnutrition risk screening. A prospective multi-methods study was conducted in a 750-bed public hospital in Australia. Patients were recruited from seven wards and asked to complete an electronic version of the Malnutrition Screening Tool (e-MST) on bedside computer screens. Data were collected on feasibility, acceptability, and cost. Feasibility data were compared to pre-determined criteria on recruitment (≥50% recruitment rate) and e-MST completion (≥75% completion rate). Quantitative acceptability (survey) data were analyzed descriptively. Patient interview data were analyzed thematically. The economic evaluation was from the perspective of the health service using a decision tree analytic model. Both feasibility criteria were met; the recruitment rate was 78% and all 121 participants (52% male, median age 59 [IQR 48-69] years) completed the e-MST. Patient acceptability was high. Patient-led e-MST was modeled to save $3.23 AUD per patient and yield 6.5 more true malnutrition cases (per 121 patients) with an incremental cost saving per additional malnutrition case of 0.50 AUD. Patient-led, technology-assisted malnutrition risk screening was found to be feasible, acceptable to patients, and cost-effective (higher malnutrition yield and less costly) compared to current practice at this hospital.
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Affiliation(s)
- Shelley Roberts
- School of Health Sciences and Social Work, Griffith University, Southport, QLD 4222, Australia;
- Allied Health Research, Gold Coast Hospital and Health Service, Southport, QLD 4215, Australia
| | - Andrea P. Marshall
- School of Nursing and Midwifery, Griffith University, Southport, QLD 4222, Australia;
- Nursing and Midwifery Education and Research Unit, Gold Coast Hospital and Health Service, Southport, QLD 4215, Australia
| | - Leisa Bromiley
- Nutrition and Food Services, Gold Coast Hospital and Health Service, Southport, QLD 4215, Australia;
| | - Zane Hopper
- School of Health Sciences and Social Work, Griffith University, Southport, QLD 4222, Australia;
- Nutrition and Food Services, Gold Coast Hospital and Health Service, Southport, QLD 4215, Australia;
| | - Joshua Byrnes
- Centre for Applied Health Economics, Menzies Health Institute Queensland, Griffith University, Southport, QLD 4222, Australia;
- School of Medicine and Dentistry, Griffith University, Southport, QLD 4222, Australia
| | - Lauren Ball
- Centre for Community Health and Wellbeing, The University of Queensland, St Lucia, QLD 4072, Australia;
| | - Peter F. Collins
- Faculty of Medicine and Health, Sydney Nursing School/Susan Wakil School of Nursing and Midwifery, The University of Sydney, Sydney, NSW 2006, Australia;
- Charles Perkins Centre, The University of Sydney, Sydney, NSW 2006, Australia
| | - Jaimon Kelly
- Centre for Online Health, The University of Queensland, Woolloongabba, QLD 4102, Australia;
- Centre for Health Services Research, The University of Queensland, Woolloongabba, QLD 4102, Australia
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16
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Cox NJ. Consequences of Anorexia of Aging in Hospital Settings: An Updated Review. Clin Interv Aging 2024; 19:451-457. [PMID: 38496748 PMCID: PMC10941985 DOI: 10.2147/cia.s431547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 02/27/2024] [Indexed: 03/19/2024] Open
Abstract
The anorexia of aging is a widespread problem amongst older people, particularly in the hospital setting with up to 60% affected. Despite its high prevalence anorexia often goes undiagnosed in hospital, due to a lack of standardized assessment and evidence-based management, but also lack of knowledge regarding consequences. This review summarizes current evidence for anorexia of aging specific to the hospital setting, giving an overview of correlates of appetite in hospital and consequences of anorexia. It highlights an overall scarcity of research on this important clinical problem for hospitalized cohorts. The few studies point to the importance of anorexia of aging in major health burdens for older people, namely malnutrition, sarcopenia and reduced physical performance, as well as higher mortality. Further research is needed to assess temporal sequence in pathways of causality and to develop effective interventions to combat anorexia.
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Affiliation(s)
- Natalie J Cox
- Academic Geriatric Medicine, Faculty of Medicine, University of Southampton, Southampton, UK
- NIHR Applied Research Collaboration (ARC) Wessex, University of Southampton, Southampton, UK
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17
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Kitson A, Carr D, Feo R, Conroy T, Jeffs L. The ILC Maine statement: Time for the fundamental care [r]evolution. J Adv Nurs 2024. [PMID: 38379317 DOI: 10.1111/jan.16108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 02/05/2024] [Accepted: 02/06/2024] [Indexed: 02/22/2024]
Abstract
AIM The aim of this study was to present the third position statement from the International Learning Collaborative (ILC). The ILC is the foremost global organization dedicated to transforming fundamental care. Internationally, fundamental care is reported to be poorly delivered, delayed or missed, negatively impacting patients, their families/carers and healthcare staff and systems. Overcoming this global challenge requires profound transformation in how our healthcare systems value, deliver and evaluate fundamental care. This transformation will take both evolutionary and revolutionary guises. In this position statement, we argue how this [r]evolutionary transformation for fundamental care can and must be created within clinical practice. DESIGN Position paper. METHODS This position statement stems from the ILC's annual conference and Leadership Program held in Portland, Maine, USA, in June 2023. The statement draws on the discussions between participants and the authors' subsequent reflections and synthesis of these discussions and ideas. The conference and Leadership Program involved participants (n = 209) from 13 countries working primarily within clinical practice. RESULTS The statement focuses on what must occur to transform how fundamental care is valued, prioritized and delivered within clinical practice settings globally. To ensure demonstrable change, the statement comprises four action-oriented strategies that must be systematically owned by healthcare staff and leaders and embedded in our healthcare organizations and systems: Address non-nursing tasks: reclaim and protect time to provide high-value fundamental care. Accentuate the positive: change from deficit-based to affirmative language when describing fundamental care. Access evidence and assess impact: demonstrate transformation in fundamental care by generating relevant indicators and impact measures and rigorously synthesizing existing research. Advocate for interprofessional collaboration: support high-quality, transdisciplinary fundamental care delivery via strong nursing leadership. CONCLUSION The ILC Maine Statement calls for ongoing action - [r]evolution - from healthcare leaders and staff within clinical practice to prioritize fundamental care throughout healthcare systems globally. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE We outline four action-oriented strategies that can be embedded within clinical practice to substantially transform how fundamental care is delivered. Specific actions to support these strategies are outlined, providing healthcare leaders and staff a road map to continue the transformation of fundamental care within our healthcare systems. IMPACT Fundamental care affects everyone across their life course, regardless of care context, clinical condition, age and/or the presence of disability. This position statement represents a call to action to healthcare leaders and staff working specifically in clinical practice, urging them to take up the leadership challenge of transforming how fundamental care is delivered and experience globally. PATIENT OR PUBLIC CONTRIBUTION Patients, service users and caregivers were involved in the ILC annual conference, thus contributing to the discussions that shaped this position statement. WHAT DOES THIS PAPER CONTRIBUTE TO THE WIDER GLOBAL CLINICAL COMMUNITY?: The strategies and actions outlined in this position statement are relevant to all clinical settings globally, providing practical strategies and actions that can be employed to enhance fundamental care for all patients and their families/carers. By outlining the importance of both evolutionary and revolutionary change, we identify ways in which healthcare systems globally can begin making the necessary steps towards radical fundamental care transformation, regardless of where they are in the change journey.
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Affiliation(s)
- Alison Kitson
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
- The International Learning Collaborative, Adelaide, South Australia, Australia
| | - Devin Carr
- The International Learning Collaborative, Adelaide, South Australia, Australia
- Maine Medical Center, Portland, Maine, USA
| | - Rebecca Feo
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
- The International Learning Collaborative, Adelaide, South Australia, Australia
| | - Tiffany Conroy
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
- The International Learning Collaborative, Adelaide, South Australia, Australia
| | - Lianne Jeffs
- The International Learning Collaborative, Adelaide, South Australia, Australia
- Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, Ontario, Canada
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Zhou B, Zhang Y, Hiesmayr M, Gao X, Huang Y, Liu S, Shen R, Zhao Y, Cui Y, Zhang L, Wang X. Dietary Provision, GLIM-Defined Malnutrition and Their Association with Clinical Outcome: Results from the First Decade of nutritionDay in China. Nutrients 2024; 16:569. [PMID: 38398893 PMCID: PMC10893253 DOI: 10.3390/nu16040569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 02/04/2024] [Accepted: 02/16/2024] [Indexed: 02/25/2024] Open
Abstract
Malnutrition is a common and serious issue that worsens patient outcomes. The effects of dietary provision on the clinical outcomes of patients of different nutritional status needs to be verified. This study aimed to identify dietary provision in patients with eaten quantities of meal consumption and investigate the effects of dietary provision and different nutritional statuses defined by the GLIM criteria on clinical outcomes based on data from the nutritionDay surveys in China. A total of 5821 adult in-patients from 2010 to 2020 were included in this study's descriptive and Cox regression analyses. Rehabilitation and home discharge of 30-day outcomes were considered a good outcome. The prevalence of malnutrition defined by the GLIM criteria was 22.8%. On nutritionDay, 51.8% of all patients received dietary provisions, including hospital food and a special diet. In multivariable models adjusting for other variables, the patients receiving dietary provision had a nearly 1.5 higher chance of a good 30-day outcome than those who did not. Malnourished patients receiving dietary provision had a 1.58 (95% CI [1.36-1.83], p < 0.001) higher chance of having a good 30-day outcome and had a shortened length of hospital stay after nutritionDay (median: 7 days, 95% CI [6-8]) compared to those not receiving dietary provision (median: 11 days, 95% CI [10-13]). These results highlight the potential impacts of the dietary provision and nutritional status of in-patients on follow-up outcomes and provide knowledge on implementing targeted nutrition care.
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Affiliation(s)
- Bei Zhou
- Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, 305 East Zhongshan Road, Nanjing 210002, China; (B.Z.); (Y.Z.); (X.G.)
- Department of Nutrition, Acupuncture, Moxibustion and Massage College, Health Preservation and Rehabilitation College, Nanjing University of Chinese Medicine, 138 Xianlin Road, Nanjing 210023, China
| | - Yupeng Zhang
- Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, 305 East Zhongshan Road, Nanjing 210002, China; (B.Z.); (Y.Z.); (X.G.)
| | - Michael Hiesmayr
- Center for Medical Data Science, Section for Medical Statistics, Medical University Vienna, Spitalgasse 23, A-1090 Vienna, Austria;
| | - Xuejin Gao
- Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, 305 East Zhongshan Road, Nanjing 210002, China; (B.Z.); (Y.Z.); (X.G.)
| | - Yingchun Huang
- Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, 305 East Zhongshan Road, Nanjing 210002, China; (B.Z.); (Y.Z.); (X.G.)
| | - Sitong Liu
- Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, 305 East Zhongshan Road, Nanjing 210002, China; (B.Z.); (Y.Z.); (X.G.)
| | - Ruting Shen
- Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, 305 East Zhongshan Road, Nanjing 210002, China; (B.Z.); (Y.Z.); (X.G.)
| | - Yang Zhao
- Department of Biostatistics, School of Public Health, Nanjing Medical University, 101 Longmian Avenue, Nanjing 211166, China;
| | - Yao Cui
- Department of Nutrition, Pizhou Hospital, Xuzhou Medical University, Xuzhou 221004, China;
| | - Li Zhang
- Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, 305 East Zhongshan Road, Nanjing 210002, China; (B.Z.); (Y.Z.); (X.G.)
| | - Xinying Wang
- Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, 305 East Zhongshan Road, Nanjing 210002, China; (B.Z.); (Y.Z.); (X.G.)
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Haenggi E, Kaegi-Braun N, Wunderle C, Tribolet P, Mueller B, Stanga Z, Schuetz P. Red blood cell distribution width (RDW) - A new nutritional biomarker to assess nutritional risk and response to nutritional therapy? Clin Nutr 2024; 43:575-585. [PMID: 38242035 DOI: 10.1016/j.clnu.2024.01.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 12/29/2023] [Accepted: 01/02/2024] [Indexed: 01/21/2024]
Abstract
BACKGROUND & AIMS Red cell distribution width (RDW) has been proposed as a surrogate marker for acute and chronic diseases and may be influenced by nutritional deficits. We assessed the prognostic value of RDW regarding clinical outcomes and nutritional treatment response among medical inpatients at nutritional risk. METHODS This is a secondary analysis of EFFORT, a randomized, controlled, prospective, multicenter trial investigating the effects of nutritional support in patients at nutritional risk in eight Swiss hospitals. We examined the association between RDW and mortality in regression analysis. RESULTS Among 1,244 included patients (median age 75 years, 46.6 % female), high RDW (≥15 %) levels were found in 38 % of patients (n = 473) with a significant association of higher malnutrition risk [OR 1.48 (95%CI 1.1 to 1.98); p = 0.009]. Patients with high RDW had a more than doubling in short-term (30 days) mortality risk [adjusted HR 2.12 (95%CI 1.44 to 3.12); p < 0.001] and a signficant increase in long-term (5 years) mortality risk [adjusted HR 1.73 (95%CI 1.49 to 2.01); p < 0.001]. Among patients with high RDW, nutritional support reduced morality within 30 days [adjusted OR 0.56 (95%CI 0.33 to 0.96); p = 0.035], while the effect of the nutritional intervention in patients with low RDW was markedly smaller. CONCLUSIONS Among medical patients at nutritional risk, RDW correlated with several nutritional parameters and was a strong prognostic marker for adverse clinical outcomes at short- and long-term, respectively. Patients with high baseline RDW levels also showed a strong benefit from the nutritional intervention. Further research is needed to understand whether monitoring of RDW over time severs as a nutritional biomarker to assess effectiveness of nutritional treatment in the long run. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02517476.
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Affiliation(s)
- Eliane Haenggi
- Division of General Internal and Emergency Medicine, Medical University Department, Kantonsspital Aarau, 5001 Aarau, Switzerland
| | - Nina Kaegi-Braun
- Division of General Internal and Emergency Medicine, Medical University Department, Kantonsspital Aarau, 5001 Aarau, Switzerland
| | - Carla Wunderle
- Division of General Internal and Emergency Medicine, Medical University Department, Kantonsspital Aarau, 5001 Aarau, Switzerland
| | - Pascal Tribolet
- Division of General Internal and Emergency Medicine, Medical University Department, Kantonsspital Aarau, 5001 Aarau, Switzerland; Department of Health Professions, Bern University of Applied Sciences, 3008 Bern, Switzerland; Department of Nutritional Sciences and Research Platform Active Ageing, University of Vienna, 1090 Vienna, Austria
| | - Beat Mueller
- Division of General Internal and Emergency Medicine, Medical University Department, Kantonsspital Aarau, 5001 Aarau, Switzerland; Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Zeno Stanga
- Division of Diabetes, Endocrinology, Nutritional Medicine & Metabolism, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Philipp Schuetz
- Division of General Internal and Emergency Medicine, Medical University Department, Kantonsspital Aarau, 5001 Aarau, Switzerland; Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland.
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20
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Clode M, Tran D, Majumdar A, Ayer J, Ferrie S, Cordina R. Nutritional considerations for people living with a Fontan circulation: a narrative review. Cardiol Young 2024; 34:238-249. [PMID: 38258459 DOI: 10.1017/s1047951123004389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
The population of people living with a Fontan circulation are highly heterogenous, including both children and adults, who have complex health issues and comorbidities associated with their unique physiology throughout life. Research focused on nutritional considerations and interventions in the Fontan population is extremely limited beyond childhood. This review article discusses the current literature examining nutritional considerations in the setting of Fontan physiology and provides an overview of the available evidence to support nutritional management strategies and future research directions. Protein-losing enteropathy, growth deficits, bone mineral loss, and malabsorption are well-recognised nutritional concerns within this population, but increased adiposity, altered glucose metabolism, and skeletal muscle deficiency are also more recently identified issues. Emergencing evidence suggets that abnormal body composition is associated with poor circulatory function and health outcomes. Many nutrition-related issues, including the impact of congenital heart disease on nutritional status, factors contributing to altered body composition and comorbidities, as well as the role of the microbiome and metabolomics, remain poodly understood.
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Affiliation(s)
- Melanie Clode
- The University of Sydney, Sydney Medical School, Camperdown, NSW, Australia
- Heart Research Group, Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Derek Tran
- The University of Sydney, Sydney Medical School, Camperdown, NSW, Australia
- Heart Research Institute, Newtown, NSW, Australia
- Department of Cardiology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Avik Majumdar
- The University of Sydney, Sydney Medical School, Camperdown, NSW, Australia
| | - Julian Ayer
- The University of Sydney, Sydney Medical School, Camperdown, NSW, Australia
- The Heart Centre for Children, The Sydney Children's Hospital Network, Westmead, NSW, Australia
| | - Suzie Ferrie
- The University of Sydney, Sydney Medical School, Camperdown, NSW, Australia
- Department of Nutrition and Dietetics, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Rachael Cordina
- The University of Sydney, Sydney Medical School, Camperdown, NSW, Australia
- Heart Research Group, Murdoch Children's Research Institute, Melbourne, VIC, Australia
- Heart Research Institute, Newtown, NSW, Australia
- Department of Cardiology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
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21
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Starace E, De Pasquale G, Morenghi E, Crippa C, Matteucci S, Pieri G, Soekeland F, Gibbi SM, Lo Cricchio G, Reggiani F, Calatroni M, Pastore M, Mazzoleni B, Mancin S. Hospital Malnutrition in the Medicine and Neurology Departments: A Complex Challenge. Nutrients 2023; 15:5061. [PMID: 38140320 PMCID: PMC10745339 DOI: 10.3390/nu15245061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 12/08/2023] [Accepted: 12/09/2023] [Indexed: 12/24/2023] Open
Abstract
Hospital malnutrition is especially common among elderly patients with neurological deficits or dementia. These conditions can be exacerbated by unpalatable diets and issues such as dysphagia and presbyphagia. Our study aimed to investigate the prevalence of malnutrition in patients on a homogenized diet and to identify potential correlations with specific clinical variables. We conducted a retrospective observational study in compliance with the STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) guidelines. The study encompassed 82 patients, mainly elderly and diagnosed with neurodegenerative diseases. Upon initial assessment, 46.34% of the sample displayed a risk of malnutrition based on the Malnutrition Universal Screening Tool (MUST), and 62.20% were classified as malnourished based on the Global Leadership Initiative on Malnutrition (GLIM) criteria. Only 45.12% retained autonomy in food intake. Weight loss identified prior to the study was closely tied to malnutrition and influenced BMI. Moreover, autonomy in food intake was strongly associated with a prolonged hospital stay (LOS), and a similar trend was observed for water intake. Our findings emphasize the importance of promptly recognizing patients at risk of malnutrition, especially within such a vulnerable population. Autonomy in food intake and hydration emerge as critical indicators in the clinical management of hospitalized patients.
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Affiliation(s)
- Erica Starace
- IRCCS Humanitas Research Hospital, 20089 Milan, Italy; (E.S.); (G.D.P.); (E.M.); (C.C.); (S.M.); (G.P.); (G.L.C.); (F.R.); (M.C.); (M.P.)
| | - Giulia De Pasquale
- IRCCS Humanitas Research Hospital, 20089 Milan, Italy; (E.S.); (G.D.P.); (E.M.); (C.C.); (S.M.); (G.P.); (G.L.C.); (F.R.); (M.C.); (M.P.)
| | - Emanuela Morenghi
- IRCCS Humanitas Research Hospital, 20089 Milan, Italy; (E.S.); (G.D.P.); (E.M.); (C.C.); (S.M.); (G.P.); (G.L.C.); (F.R.); (M.C.); (M.P.)
- Department of Biomedical Sciences, Humanitas University, 20072 Milan, Italy;
| | - Camilla Crippa
- IRCCS Humanitas Research Hospital, 20089 Milan, Italy; (E.S.); (G.D.P.); (E.M.); (C.C.); (S.M.); (G.P.); (G.L.C.); (F.R.); (M.C.); (M.P.)
| | - Sofia Matteucci
- IRCCS Humanitas Research Hospital, 20089 Milan, Italy; (E.S.); (G.D.P.); (E.M.); (C.C.); (S.M.); (G.P.); (G.L.C.); (F.R.); (M.C.); (M.P.)
| | - Gabriella Pieri
- IRCCS Humanitas Research Hospital, 20089 Milan, Italy; (E.S.); (G.D.P.); (E.M.); (C.C.); (S.M.); (G.P.); (G.L.C.); (F.R.); (M.C.); (M.P.)
| | - Fanny Soekeland
- School of Health Professions, University of Applied Sciences, 3008 Bern, Switzerland;
| | - Stefano Maria Gibbi
- Department of Drug Science, School of Pharmacy, University of Pavia, 27100 Pavia, Italy;
| | - Giuliana Lo Cricchio
- IRCCS Humanitas Research Hospital, 20089 Milan, Italy; (E.S.); (G.D.P.); (E.M.); (C.C.); (S.M.); (G.P.); (G.L.C.); (F.R.); (M.C.); (M.P.)
| | - Francesco Reggiani
- IRCCS Humanitas Research Hospital, 20089 Milan, Italy; (E.S.); (G.D.P.); (E.M.); (C.C.); (S.M.); (G.P.); (G.L.C.); (F.R.); (M.C.); (M.P.)
| | - Marta Calatroni
- IRCCS Humanitas Research Hospital, 20089 Milan, Italy; (E.S.); (G.D.P.); (E.M.); (C.C.); (S.M.); (G.P.); (G.L.C.); (F.R.); (M.C.); (M.P.)
| | - Manuela Pastore
- IRCCS Humanitas Research Hospital, 20089 Milan, Italy; (E.S.); (G.D.P.); (E.M.); (C.C.); (S.M.); (G.P.); (G.L.C.); (F.R.); (M.C.); (M.P.)
| | - Beatrice Mazzoleni
- Department of Biomedical Sciences, Humanitas University, 20072 Milan, Italy;
| | - Stefano Mancin
- IRCCS Humanitas Research Hospital, 20089 Milan, Italy; (E.S.); (G.D.P.); (E.M.); (C.C.); (S.M.); (G.P.); (G.L.C.); (F.R.); (M.C.); (M.P.)
- Department of Biomedical Sciences, Humanitas University, 20072 Milan, Italy;
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Ferguson CE, Tatucu-Babet OA, Amon JN, Chapple LAS, Malacria L, Myint Htoo I, Hodgson CL, Ridley EJ. Dietary assessment methods for measurement of oral intake in acute care and critically ill hospitalised patients: a scoping review. Nutr Res Rev 2023:1-14. [PMID: 38073417 DOI: 10.1017/s0954422423000288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
Quantification of oral intake within the hospital setting is required to guide nutrition care. Multiple dietary assessment methods are available, yet details regarding their application in the acute care setting are scarce. This scoping review, conducted in accordance with JBI methodology, describes dietary assessment methods used to measure oral intake in acute and critical care hospital patients. The search was run across four databases to identify primary research conducted in adult acute or critical care settings from 1st of January 2000-15th March 2023 which quantified oral diet with any dietary assessment method. In total, 155 articles were included, predominantly from the acute care setting (n = 153, 99%). Studies were mainly single-centre (n = 138, 88%) and of observational design (n = 135, 87%). Estimated plate waste (n = 59, 38%) and food records (n = 43, 28%) were the most frequent assessment methods with energy and protein the main nutrients quantified (n = 81, 52%). Validation was completed in 23 (15%) studies, with the majority of these using a reference method reliant on estimation (n = 17, 74%). A quarter of studies (n = 39) quantified completion (either as complete versus incomplete or degree of completeness) and four studies (2.5%) explored factors influencing completion. Findings indicate a lack of high-quality evidence to guide selection and application of existing dietary assessment methods to quantify oral intake with a particular absence of evidence in the critical care setting. Further validation of existing tools and identification of factors influencing completion is needed to guide the optimal approach to quantification of oral intake in both research and clinical contexts.
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Affiliation(s)
- Clare E Ferguson
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Dietetics and Nutrition Department, Alfred Health, Melbourne, Victoria, Australia
| | - Oana A Tatucu-Babet
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Dietetics and Nutrition Department, Alfred Health, Melbourne, Victoria, Australia
| | - Jenna N Amon
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Dietetics and Nutrition Department, Alfred Health, Melbourne, Victoria, Australia
| | - Lee-Anne S Chapple
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
- Intensive Care Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, South Australia, Australia
| | - Lauren Malacria
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Ivy Myint Htoo
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Carol L Hodgson
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Division of Clinical Trials and Cohort Studies, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Critical Care, University of Melbourne, Melbourne, Victoria, Australia
- The George Institute for Global Health, Sydney, NSW, Australia
- Physiotherapy Department, Alfred Health, Melbourne, Victoria, Australia
| | - Emma J Ridley
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Dietetics and Nutrition Department, Alfred Health, Melbourne, Victoria, Australia
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Ng DHL, Koh FHX, Yeong HEL, Huey TCW, Chue KM, Foo FJ, Chew STH. Nutrition Care after Hospital Discharge in Singapore: Evidence-Based Best-Practice Recommendations. Nutrients 2023; 15:4492. [PMID: 37960145 PMCID: PMC10650134 DOI: 10.3390/nu15214492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 10/11/2023] [Accepted: 10/18/2023] [Indexed: 11/15/2023] Open
Abstract
The nutritional status of hospitalised patients is often at risk or compromised and predisposed to further deterioration after discharge, leading to poor clinical outcomes, high healthcare costs, and poor quality of life. This paper aims to provide evidence-based best-practice recommendations to address this, supported by a national survey of healthcare professionals in Singapore and reviewed by a multidisciplinary expert panel under the Sarcopenia Interest Group of Society of Parenteral and Enteral Nutrition Singapore (SingSPEN). We advocate screening all patients with a validated tool which includes a disease activity/burden component, an easily accessible dietitian referral pathway for patients at risk of malnutrition, and an individualised nutrition care plan formulated and delivered using a multidisciplinary team approach for patients at risk or with malnutrition. A comprehensive team would include not only dietitians but also physicians, nurses, physiotherapists, speech therapists, and medical social workers working together towards a common goal. Information on why nutrition is important for good health and how it can be achieved should also be provided to all patients and their caregivers before and after hospital discharge. With the above recommendations, we seek to improve upon the current nutrition care processes at discharge for healthcare institutions in Singapore.
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Affiliation(s)
- Doris Hui Lan Ng
- Department of Gastroenterology and Hepatology, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore;
| | - Frederick Hong Xiang Koh
- Department of General Surgery, Sengkang General Hospital, 110 Sengkang East Way, Singapore 544886, Singapore; (F.H.X.K.); (K.M.C.)
| | - Hazel Ee Ling Yeong
- Department of Nutrition and Dietetics, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore 768828, Singapore;
| | - Terence Cheong Wei Huey
- Department of General Surgery, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore;
| | - Koy Min Chue
- Department of General Surgery, Sengkang General Hospital, 110 Sengkang East Way, Singapore 544886, Singapore; (F.H.X.K.); (K.M.C.)
| | - Fung Joon Foo
- Department of General Surgery, Sengkang General Hospital, 110 Sengkang East Way, Singapore 544886, Singapore; (F.H.X.K.); (K.M.C.)
| | - Samuel Teong Huang Chew
- Department of Geriatric Medicine, Changi General Hospital, 2 Simei St 3, Singapore 529889, Singapore;
- SingHealth Duke-NUS Medicine Academic Clinical Programme, 8 College Road, Singapore 169857, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Drive, Singapore 117597, Singapore
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Li S, Lio KU, Ho TA, Wang Y, Rali P. Effect of malnutrition on outcomes of hospitalisations for acute pulmonary embolism: a national inpatient database study. BMJ Nutr Prev Health 2023; 6:188-195. [PMID: 38618531 PMCID: PMC11009544 DOI: 10.1136/bmjnph-2023-000705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 09/19/2023] [Indexed: 04/16/2024] Open
Abstract
Background To evaluate the occurrence of malnutrition in pulmonary embolism (PE)-related hospitalisations and assess the impact of malnutrition on the outcomes of patients with PE. Methods A retrospective observational study using data extracted from the Nationwide Inpatient Sample from 2016 to 2018. Hospitalisations with a principal diagnosis of PE were obtained using International Classification of Diseases, Tenth Revision codes and divided into groups based on a secondary diagnosis of malnutrition. Results Of 563 135 PE hospitalisations, 30 495 (5.4%) had malnutrition. PE patients with malnutrition were older (mean age±SD, 69.1±14.5 vs 62.3±16.6, p<0.001) and with higher Charlson Comorbidity Index score (3 to 5, 24.8% vs 12.9%, p<0.001). Concurrent malnutrition was associated with higher adjusted OR (aOR) of in-hospital mortality (aOR 2.43, 95% CI 2.18 to 2.70, p<0.001), acute kidney injury (aOR 1.56, 95% CI 1.45 to 1.67, p<0.001), sepsis (aOR 4.37, 95% CI 3.79 to 5.03, p<0.001), shock (aOR 2.52, 95% CI 2.25 to 2.81, p<0.001), acidosis (aOR 2.55, 95% CI 2.34 to 2.77, p<0.001) and mechanical ventilation (aOR 2.95, 95% CI 2.61 to 3.33, p<0.001). Patients with PE and malnutrition had an increased mean length of stay (adjusted difference 3.39 days, 95% CI 3.14 to 3.65, p<0.001), hospital charges (adjusted difference US$34 802.11, 95% CI US$31 005.01 to US$38 599.22, p<0.001) and costs (adjusted difference US$8 332.01, 95% CI US$7489.09 to US$9174.94, p<0.001). Conclusion Concurrent PE and malnutrition were associated with worse outcomes. The study highlights the importance of identifying malnutrition in patients with PE to improve outcomes and reduce healthcare utilisation.
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Affiliation(s)
- Si Li
- Department of Medicine, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
| | - Ka U Lio
- Department of Medicine, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
| | - Truong-An Ho
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
| | - Yichen Wang
- Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Parth Rali
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
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25
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Alito A, Portaro S, Leonardi G, Ventimiglia C, Bonanno F, Fenga D, Sconza C, Tisano A. Pressure Ulcers-A Longstanding Problem: A 7-Year Neurorehabilitation Unit Experience of Management, Care, and Clinical Outcomes. Diagnostics (Basel) 2023; 13:3213. [PMID: 37892035 PMCID: PMC10605717 DOI: 10.3390/diagnostics13203213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 09/19/2023] [Accepted: 10/12/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Neurological disease patients present an increased risk of developing pressure ulcers. The primary aim of this study is to evaluate the incidence and prevalence of pressure ulcers and their impact on length of stay and functional recovery. METHODS A retrospective study was conducted in a neurorehabilitation unit over a seven-year period. Data collected include demographic data, length of stay, functional evaluation, risk of pressure ulcers development, nutritional status, and skin. Pressure ulcers were classified according to the European Pressure Ulcer Advisory Panel System. RESULTS Data from 816 patients were analyzed. On admission, the authors found 236 pressure ulcers in 131 patients (about 16%), divided into stage I (25%), stage II (50%), and stage III-IV (25%). The most common sites were the heel (36%) and sacrum (29%). Among the risk factors for the development of pressure ulcers, malnutrition played a significant role, with approximately 76% of patients with pressure ulcers having mild to moderate malnutrition. CONCLUSION The presence of pressure ulcers seems to have a negative impact on the functional recovery of patients, as shown by the outcome scales and the average length of stay: 51 days versus 36 days (p < 0.01).
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Affiliation(s)
- Angelo Alito
- Department of Biomedical, Dental Sciences and Morphological and Functional Images, University of Messina, 98125 Messina, Italy
| | - Simona Portaro
- Physical Rehabilitation Medicine Department, University Hospital A.O.U. “G. Martino”, 98125 Messina, Italy
| | - Giulia Leonardi
- Physical Rehabilitation Medicine Department, University Hospital A.O.U. “G. Martino”, 98125 Messina, Italy
| | - Carlotta Ventimiglia
- Department of Adult and Developmental Human Pathology, University of Messina, 98125 Messina, Italy;
| | - Francesco Bonanno
- Department of Clinical and Experimental Medicine, University of Messina, 98125 Messina, Italy; (A.T.); (F.B.)
| | - Domenico Fenga
- Department of Orthopaedics and Traumatology, University Hospital A.O.U. “G. Martino”, 98125 Messina, Italy
| | - Cristiano Sconza
- IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20090 Milan, Italy
| | - Adriana Tisano
- Department of Clinical and Experimental Medicine, University of Messina, 98125 Messina, Italy; (A.T.); (F.B.)
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Gonçalves F, Cabral S, Moreira AP, Cunha J, Magalhães B. Characterization and monitoring of nutritional risk and nutritional status in oncological patients admitted to an oncological surgery unit: A longitudinal study. Clin Nutr ESPEN 2023; 57:637-646. [PMID: 37739717 DOI: 10.1016/j.clnesp.2023.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 08/06/2023] [Accepted: 08/14/2023] [Indexed: 09/24/2023]
Abstract
BACKGROUND AND AIMS malnutrition is a common phenomenon in people with cancer and can occur at all stages of the disease trajectory. Prevention, early identification of patients at risk of malnutrition, nutritional diagnosis, and personalized intervention, monitoring and follow-up are essential measures to minimize the occurrence of malnutrition and its consequences. This study aims to evaluate if current institutional practices regarding nutritional intervention guarantees nutritional/dietary care for cancer patients. METHODS adescriptive, analytical and longitudinal study was carried out, lasting five months, in a hospital inpatient surgical oncology unit. All patients admitted to the unit in the period between 1 March and 31 July 2022, who underwent nutritional screening at the time of admission to the service, were included. During hospitalization, they were subjected to periodic assessments of weight, body mass index and nutritional screening every 7 days until discharge. RESULTS a total of 659 patients were admitted to the inpatient unit. The highest prevalence of malnutrition was observed in Head and Neck (37.6%), Genitourinary (30.8%) and Digestive (27.7%) cancers. Weight loss was especially significant in digestive, skin and sarcoma cancers, as well as genitourinary cancers, but not in breast cancer patients. During the hospitalization period, 14.0% of the hospitalized patients received nutrition-related nursing intervention, and 21.5% were referred for clinical dietetic intervention (by a registered dietitian). CONCLUSION this work reinforces the high prevalence of malnutrition in oncological patients and the need to systematically track cancer patients throughout their disease/treatment trajectory, from admission to the hospital, to the day of admission to inpatient unit, and subsequent follow-up. We also propose expedited referrals to different specialized centres in nutritional support for cancer patients from the first day of hospitalization. Assessment of patients should always be accompanied by active referral capacity to a specialized and duly trained nutritional care team that is quick, proactive, and responsive.
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Affiliation(s)
- Filipe Gonçalves
- University of A Coruña, Faculty of Health Sciences, Campuz de Oza, 15006, A Coruña, Spain; Faculty of Nutrition and Food Sciences, University of Porto, 4150-180, Porto, Portugal.
| | - Sónia Cabral
- Portuguese Oncology Institute of Porto, IPOPFG, EPE, 4200-072, Porto, Portugal
| | - Ana Paula Moreira
- Portuguese Oncology Institute of Porto, IPOPFG, EPE, 4200-072, Porto, Portugal
| | - Joana Cunha
- Portuguese Oncology Institute of Porto, IPOPFG, EPE, 4200-072, Porto, Portugal
| | - Bruno Magalhães
- School of Health, University of Trás-os-Montes and Alto Douro (ESS-UTAD), 5000-801, Vila Real, Portugal; Clinical Academic Centre of Trás-os-Montes and Alto Douro (CACTMAD), Vila Real, Portugal; Oncology Nursing Research Unit, IPO-Porto Research (CI-POP), Portuguese Oncology Institute of Porto, Portugal (IPO-Porto)/Porto Comprehensive Cancer Center (Porto. CCC) & Rise@CI-IPOP (Health Research Network), Porto, Portugal
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27
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Li X, Yuan L, Gao B, Chen W, Wang S, Xie Y, Zhang X, Chen X. Comparison of diagnosis-related group based reimbursement and case-mix index within hospitalized patients before and after modified malnutrition diagnosis. Asia Pac J Clin Nutr 2023; 32:356-361. [PMID: 37789656 PMCID: PMC11090391 DOI: 10.6133/apjcn.202309_32(3).0007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 07/29/2023] [Accepted: 05/31/2023] [Indexed: 10/05/2023]
Abstract
BACKGROUND AND OBJECTIVES Lack of professional and accurate diagnosis of malnutrition led to a reduction in Diagnosis Related Group (DRG) payment and a decrease in Case-Mix Index (CMI). The aim of this study was to explore the effects of adding a proper nutritional diagnosis and modifying complication groups on DRG payment and CMI. METHODS AND STUDY DESIGN Retrospective analysis was performed on patients ad-mitted to the hospital from January to June 2022 who had received a nutritional assessment. Patients were diagnosed as well-nourished, mild malnutrition, moderate malnutrition or severe malnutrition according to patient-generated subjective global assessment (PG-SGA) scores within 24 hours of admission. CMI and DRG hospital internal control standards were recalculated and compared with the original values. RESULTS A total of 254 patients were enrolled, including 40 patients with mild malnutrition, 74 patients with moderate malnutrition and 122 patients with severe malnutrition. Of all subjects, 111 changed complication groups. The median of the DRG hospital internal control standard (12006.09 vs. 13797.19, p=0.01) and the median of CMI (0.91 vs. 1.04, p=0.026) were significantly higher than those before the diagnostic change. In patients with inflammatory bowel disease (IBD), the CMI value, hospital control standard of DRG, and the classification of DRG were significantly different from those before diagnosis revision (p<0.001). CONCLUSIONS Fully identification and correct coding of malnutrition cases are conducive for hospitals to receive appropriate DRG compensation, and further contribute to the improvement of medical quality and the economic sustain-ability of hospitals.
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Affiliation(s)
- Xiangrui Li
- Department of Clinical Nutrition, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nan-jing University, Nanjing, China
| | - Lihua Yuan
- Department of Interventional Radiology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Bo Gao
- Department of Clinical Nutrition, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nan-jing University, Nanjing, China
| | - Wenqing Chen
- Department of Clinical Nutrition, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nan-jing University, Nanjing, China
| | - Shu'an Wang
- Department of Clinical Nutrition, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nan-jing University, Nanjing, China
| | - Ying Xie
- Department of Gastroenterology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nan-jing University, Nanjing, China
| | - Xiaoqi Zhang
- Department of Gastroenterology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nan-jing University, Nanjing, China.
| | - Xiaotian Chen
- Department of Clinical Nutrition, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nan-jing University, Nanjing, China.
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28
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Tóth B, Dénes Z, Németh M, Fazekas G. Changes in skeletal muscle mass index and fat mass index during rehabilitation for traumatic brain injury and stroke measured by bioelectrical impedance analysis. Int J Rehabil Res 2023; 46:264-269. [PMID: 37334827 DOI: 10.1097/mrr.0000000000000587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
Although malnutrition may negatively impact the outcomes of rehabilitation and increase the cost of care, there are still no valid nutritional assessment methods appropriate for specific groups of patients undergoing rehabilitation. This study aimed to determine if a multifrequency bioelectrical impedance is suitable for monitoring the changes in body composition of brain-injured patients for whom individualized nutritional goals were set during rehabilitation. Fat mass index (FMI) and skeletal muscle mass index (SMMI) were examined by Seca mBCA515 or portable Seca mBCA525 device within 48 h of admission and before discharge in 11 traumatic brain injury (TBI) and 11 stroke patients with admission Nutritional Risk Screening 2002 scores ≥2. The changes in outcomes and plausible interactions were examined between the admission values and the values estimated for the 18th day (minimum length of stay in the sample) using a repeated measure mixed-sample analysis of covariance. In patients with low FMI at admission (mainly younger, TBI patients, with longer ICU stay), there was no change over time whereas, in those with high admission FMI (older, stroke patients, with shorter ICU stay), a decrease was observed (significant interaction F(1,19) = 9.224 P = 0.007 Part. η² = 0.327). The SMMI significantly increased over time (F(1,19) = 5.202 P = 0.034 Part. η² = 0.215) independently of gender, age, days spent in ICU and cause of brain injury. Our results suggest that bioelectrical impedance analysis is feasible and informative for monitoring the changes in body composition during rehabilitation, which also requires consideration of demographic and pre-rehabilitation characteristics.
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Affiliation(s)
- Babett Tóth
- Rehabilitation Department of Brain injuries, Department for Rehabilitation post Stroke, Department of Alimentation and Dietetics, National Institute of Locomotor Diseases and Disabilities/National Institute for Medical Rehabilitation
| | - Zoltán Dénes
- Rehabilitation Department of Brain injuries, Department for Rehabilitation post Stroke, Department of Alimentation and Dietetics, National Institute of Locomotor Diseases and Disabilities/National Institute for Medical Rehabilitation
- Department of Rehabilitation Medicine, Semmelweis University, Budapest
| | - Mariann Németh
- Rehabilitation Department of Brain injuries, Department for Rehabilitation post Stroke, Department of Alimentation and Dietetics, National Institute of Locomotor Diseases and Disabilities/National Institute for Medical Rehabilitation
- Department of Rehabilitation Medicine, Semmelweis University, Budapest
| | - Gábor Fazekas
- Rehabilitation Department of Brain injuries, Department for Rehabilitation post Stroke, Department of Alimentation and Dietetics, National Institute of Locomotor Diseases and Disabilities/National Institute for Medical Rehabilitation
- University of Szeged, Szeged, Hungary
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Durán Poveda M, Suárez-de-la-Rica A, Cancer Minchot E, Ocón Bretón J, Sánchez Pernaute A, Rodríguez Caravaca G. The Prevalence and Impact of Nutritional Risk and Malnutrition in Gastrointestinal Surgical Oncology Patients: A Prospective, Observational, Multicenter, and Exploratory Study. Nutrients 2023; 15:3283. [PMID: 37513700 PMCID: PMC10385494 DOI: 10.3390/nu15143283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 07/19/2023] [Accepted: 07/19/2023] [Indexed: 07/30/2023] Open
Abstract
A prospective, observational, multicenter, and exploratory study was conducted in 469 gastrointestinal cancer patients undergoing elective surgery. The Malnutrition Universal Screening Tool (MUST) and the Global Leadership Initiative on Malnutrition (GLIM) criteria were used to assess nutritional risk. On admission, 17.9% and 21.1% of patients were at moderate (MUST score 1) and severe (MUST score ≥ 2) nutritional risk, respectively. The GLIM criteria used in patients with a MUST score ≥ 2 showed moderate malnutrition in 35.3% of patients and severe in 64.6%. Forty-seven percent of patients with a MUST score ≥ 2 on admission had the same score at discharge, and 20.7% with a MUST score 0 had moderate/severe risk at discharge. Small bowel, esophageal, and gastric cancer and diabetes were predictors of malnutrition on admission. Complications were significantly higher among patients with a MUST score 1 or ≥2 either on admission (p = 0.001) or at discharge (p < 0.0001). In patients who received nutritional therapy (n = 231), 43% continued to have moderate/severe nutritional risk on discharge, and 54% of those with MUST ≥ 2 on admission maintained this score at discharge. In gastrointestinal cancer patients undergoing elective surgery, there is an urgent need for improving nutritional risk screening before and after surgery, as well as improving nutritional therapy during hospitalization.
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Affiliation(s)
- Manuel Durán Poveda
- Department of General and Digestive Surgery, Hospital Universitario Rey Juan Carlos, 28933 Madrid, Spain
- Department of Medical Specialties and Public Health, Faculty of Health Sciences, Rey Juan Carlos University, 28933 Madrid, Spain
| | - Alejandro Suárez-de-la-Rica
- Department of Anesthesiology and Surgical Critical Care, Hospital Universitario La Princesa, 28006 Madrid, Spain
| | - Emilia Cancer Minchot
- Department of Endocrinology and Nutrition, Hospital Universitario de Fuenlabrada, 28942 Madrid, Spain
| | - Julia Ocón Bretón
- Department of Endocrinology and Nutrition, Hospital Universitario "Lozano Blesa", 50009 Zaragoza, Spain
| | - Andrés Sánchez Pernaute
- Department of General and Digestive Surgery, Hospital Clínico San Carlos, 28040 Madrid, Spain
| | - Gil Rodríguez Caravaca
- Department of Medical Specialties and Public Health, Faculty of Health Sciences, Rey Juan Carlos University, 28933 Madrid, Spain
- Department of Preventive Medicine, Hospital Universitario Fundación Alcorcón, 28922 Madrid, Spain
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30
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Elliott A, Gibson S, Bauer J, Cardamis A, Davidson Z. Exploring Overnutrition, Overweight, and Obesity in the Hospital Setting-A Point Prevalence Study. Nutrients 2023; 15:nu15102315. [PMID: 37242200 DOI: 10.3390/nu15102315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 05/12/2023] [Accepted: 05/13/2023] [Indexed: 05/28/2023] Open
Abstract
Malnutrition is an international healthcare concern associated with poor patient outcomes, increased length of stay, and healthcare costs. Although malnutrition includes both under and overnutrition, there is a large body of evidence that describes the impacts of undernutrition with limited data on overnutrition in hospitalized patients. Obesity itself is a modifiable risk factor associated with hospital-associated complications. However, there is limited reporting of the prevalence of obesity in hospitals. This one-day cross-sectional study (n = 513) captures the prevalence of both under and overnutrition in a hospitalized population and explores dietetic care provided compared to the Nutrition Care Process Model for hospitalized patients who have obesity. The main findings were: (1) the largest proportion of patients were in the overweight and obese classifications (57.3%, n = 294/513); 5.3% of these patients had severe obesity (class III); (2) patients who were overweight and obese had lower malnutrition risk profiles as well as the prevalence of malnutrition; (3) 24.1% of patients who had obesity (n = 34/141) were receiving dietetic intervention; (4) 70.6% (n = 24/34) did not have a nutrition diagnosis that followed the Nutrition Care Process Model. Study results provide valuable clinical insight into the prevalence of overnutrition and opportunities to improve nutrition care for this vulnerable patient group.
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Affiliation(s)
- Andrea Elliott
- Department Dietetics, Nutrition and Food Monash University, Notting Hill, VIC 3168, Australia
- Nutrition and Dietetics Department, Eastern Health, Box Hill, VIC 3128, Australia
| | - Simone Gibson
- Department Dietetics, Nutrition and Food Monash University, Notting Hill, VIC 3168, Australia
| | - Judy Bauer
- Department Dietetics, Nutrition and Food Monash University, Notting Hill, VIC 3168, Australia
| | - Anna Cardamis
- Nutrition and Dietetics Department, Eastern Health, Box Hill, VIC 3128, Australia
| | - Zoe Davidson
- Department Dietetics, Nutrition and Food Monash University, Notting Hill, VIC 3168, Australia
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Wu S, Zhao Y, Ning H, Hu H, Feng H. Research progress in the hospitalization-associated disability among elderly patients. ZHONG NAN DA XUE XUE BAO. YI XUE BAN = JOURNAL OF CENTRAL SOUTH UNIVERSITY. MEDICAL SCIENCES 2023; 48:455-462. [PMID: 37164929 PMCID: PMC10930072 DOI: 10.11817/j.issn.1672-7347.2023.220333] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Indexed: 05/12/2023]
Abstract
Hospitalized patients who lose one or more activities of daily living at the time of discharge compared with 2 weeks before admission (before acute onset) are referred to as hospitalization-associated disability (HAD). The incidence of HAD is high among elderly patients, which leads to the increased readmission rates, long-term care rates, and mortality, bringing a huge burden on patients, families, and society. It is vital for doctors and nurses to identify the risk factors of HAD of the elderly patients and take targeted intervention measures to prevent and improve HAD. At present, the research on HAD in foreign countries is relatively perfect, while the research on HAD in China is still in its infancy, and there is still lack of systematic research and reports on the incidence, influencing factors, and intervention measures of HAD. Domestic clinical nursing practice can learn from foreign mature interventions, carry out cultural adjustment, create a friendly environment in the hospital for elderly patients, pay attention to the assessment of the influencing factors of HAD in elderly patients, and provide personalized and patient-centered nursing measures for hospitalized elderly patients according to the assessment results, maintain their function during hospitalization and prevent the occurrence of HAD.
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Affiliation(s)
- Shuang Wu
- Xiangya Nursing School, Central South University, Changsha 410013.
| | - Yinan Zhao
- Xiangya Nursing School, Central South University, Changsha 410013
| | - Hongting Ning
- Xiangya Nursing School, Central South University, Changsha 410013
| | - Hengyu Hu
- Xiangya Nursing School, Central South University, Changsha 410013
| | - Hui Feng
- Xiangya Nursing School, Central South University, Changsha 410013.
- Xiangya-Oceanwide Health Management Research Institute, Central South University, Changsha 410013, China.
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Dent E, Wright ORL, Woo J, Hoogendijk EO. Malnutrition in older adults. Lancet 2023; 401:951-966. [PMID: 36716756 DOI: 10.1016/s0140-6736(22)02612-5] [Citation(s) in RCA: 103] [Impact Index Per Article: 103.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 11/15/2022] [Accepted: 12/01/2022] [Indexed: 01/29/2023]
Abstract
Malnutrition is a highly prevalent condition in older adults, and poses a substantial burden on health, social, and aged-care systems. Older adults are vulnerable to malnutrition due to age-related physiological decline, reduced access to nutritious food, and comorbidity. Clinical guidelines recommend routine screening for malnutrition in all older adults, together with nutritional assessment and individually tailored nutritional support for older adults with a positive screening test. Nutritional support includes offering individualised nutritional advice and counselling; oral nutritional supplements; fortified foods; and enteral or parenteral nutrition as required. However, in clinical practice, the incorporation of nutritional guidelines is inadequate and low-value care is commonplace. This Review discusses the current evidence on identification and treatment of malnutrition in older adults, identifies gaps between evidence and practice in clinical care, and offers practical strategies to translate evidence-based knowledge into improved nutritional care. We also provide an overview of the prevalence, causes, and risk factors of malnutrition in older adults across health-care settings.
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Affiliation(s)
- Elsa Dent
- Research Centre for Public Health, Equity & Human Flourishing, Torrens University Australia, Adelaide, SA, Australia.
| | - Olivia R L Wright
- School of Human Movement and Nutrition Sciences, The University of Queensland, St. Lucia, QLD, Australia
| | - Jean Woo
- Department of Medicine and Therapeutics and Centre for Nutritional Studies, Faculty of Medicine, The Chinese University of Hong Kong, Ma Liu Shui, Hong Kong Special Administrative Region, China
| | - Emiel O Hoogendijk
- Department of Epidemiology & Data Science and Department of General Practice, Location VU University Medical Center, Amsterdam UMC, Amsterdam, Netherlands; Amsterdam Public Health research institute and Ageing & Later Life Research Program, Amsterdam UMC, Amsterdam, Netherlands; Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
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Sharma Y, Horwood C, Shahi R, Hakendorf P, Thompson C. Impact of Malnutrition on Clinical Outcomes of Acutely Hospitalised Heart Failure Patients at Two Tertiary Hospitals in Australia: An Observational Study. Heart Lung Circ 2023; 32:330-337. [PMID: 36428179 DOI: 10.1016/j.hlc.2022.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 09/19/2022] [Accepted: 10/02/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND Malnutrition is common in patients with heart failure (HF) but is often neglected, despite guidelines suggesting that all hospitalised patients should undergo nutritional screening within 24-hours of admission. AIMS This study investigated the nutritional screening rates and determined the immediate and long-term clinical outcomes in patients with HF admitted at two tertiary hospitals in Australia. METHODS Nutritional screening was assessed by the Malnutrition Universal Screening Tool (MUST) completion rates. Patients were classified into two categories based on their MUST scores (0=low malnutrition risk and ≥1=at risk of malnutrition). Propensity-score-matching (PSM) was used to match 20 variables depending upon the risk of malnutrition. Clinical outcomes included the days-alive-and-out-of-hospital at 90 days of discharge (DAOH90), length of hospital stay, in-hospital, 30-day and 180-day mortality and 30-day readmissions. RESULTS There were 5,734 HF admissions between 2013-2020, of whom, only 789 (13.8%) patients underwent MUST screening. The mean (SD) age was 76.2 (14.0) years and 51.9% were males. Five-hundred and fifty-four (554) (70.2%) patients were at low malnutrition risk and 235 (29.8%) at risk of malnutrition. In HF patients, who were at risk of malnutrition, the DAOH90 were lower by 5.9 days (95% CI -11.49 to -0.42, p=0.035) and 180-day mortality was significantly worse (coefficient 0.10, 95% CI 0.02-0.18, p=0.007) compared to those who were at low risk of malnutrition. However, other clinical outcomes were similar between the two groups. CONCLUSION Nutrition screening is poor in hospitalised HF patients and long-term but not short-term clinical outcomes were worse in malnourished HF patients.
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Affiliation(s)
- Yogesh Sharma
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia; Department of General Medicine, Division of Medicine, Cardiac & Critical Care, Flinders Medical Centre, Adelaide, SA, Australia.
| | - Chris Horwood
- Department of Clinical Epidemiology, Flinders Medical Centre, Adelaide, SA, Australia
| | - Rashmi Shahi
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Paul Hakendorf
- Department of Clinical Epidemiology, Flinders Medical Centre, Adelaide, SA, Australia
| | - Campbell Thompson
- Discipline of Medicine, The University of Adelaide, Adelaide, SA, Australia
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Dietary intake in hospitals: A systematic literature review of the validity of the visual estimation method to assess food consumption and energy and protein intake. Clin Nutr ESPEN 2022; 52:296-316. [PMID: 36513469 DOI: 10.1016/j.clnesp.2022.09.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 08/09/2022] [Accepted: 09/12/2022] [Indexed: 01/28/2023]
Abstract
BACKGROUND Accurate dietary assessment is an essential component for nutrition care planning and monitoring. The visual estimation method (VEM) of dietary assessment is routinely used in hospitals around the world. Therefore, clarity regarding its validity is imperative. AIM To conduct a systematic literature review to evaluate the validity of the VEM to assess food consumption and energy and protein intake in the hospital setting. METHODS This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement and checklist. Full-text manuscripts, published in English between January 2000 and September 2021, were searched using five electronic databases. A further manual search of reference lists was conducted. RESULTS 14 studies evaluating the validity of 12 different VEMs were included. 12 studies used various point-scales (0-100%), three with pre-determined nutrient estimates assigned to each intake level, and nine without. Two studies used modern technology. Results indicate that the VEM can achieve validity at the group level, but support at the individual level was limited. No one method of visual estimation appeared to be more valid than another; however, training of raters appears to be important. CONCLUSION The VEM shows potential as a valid tool for dietary monitoring in hospitals. Further high-quality research is required to establish the effects of meal and rater characteristics on validity at the group and individual levels. Furthermore, to reflect current modes of implementation more fully, research is needed to evaluate the validity of the VEM when operated via food-service software suites.
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Corish CA. The vital role of nutrition and dietetics in the clinical management of disease and injury. Nutr Diet 2022; 79:552-554. [DOI: 10.1111/1747-0080.12787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2022] [Indexed: 11/09/2022]
Affiliation(s)
- Clare A. Corish
- Clinical Nutrition and Dietetics, School of Public Health, Physiotherapy and Sports Science University College Dublin Ireland
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Laura T, Melvin C, Yoong DY. Depressive symptoms and malnutrition are associated with other geriatric syndromes and increase risk for 30-Day readmission in hospitalized older adults: a prospective cohort study. BMC Geriatr 2022; 22:634. [PMID: 35918652 PMCID: PMC9344637 DOI: 10.1186/s12877-022-03343-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Accepted: 07/27/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Readmission in older adults is typically complex with multiple contributing factors. We aim to examine how two prevalent and potentially modifiable geriatric conditions - depressive symptoms and malnutrition - relate to other geriatric syndromes and 30-day readmission in hospitalized older adults. METHODS Consecutive admissions of patients ≥ 65 years to a general medical department were recruited over 16 months. Patients were screened for depression, malnutrition, delirium, cognitive impairment, and frailty at admission. Medical records were reviewed for poor oral intake and functional decline during hospitalization. Unplanned readmission within 30-days of discharge was tracked through the hospital's electronic health records and follow-up telephone interviews. We use directed acyclic graphs (DAGs) to depict the relationship of depressive symptoms and malnutrition with geriatric syndromes that constitute covariates of interest and 30-day readmission outcome. Multiple logistic regression was performed for the independent associations of depressive symptoms and malnutrition with 30-day readmission, adjusting for variables based on DAG-identified minimal adjustment set. RESULTS We recruited 1619 consecutive admissions, with mean age 76.4 (7.9) years and 51.3% females. 30-day readmission occurred in 331 (22.0%) of 1,507 patients with follow-up data. Depressive symptoms, malnutrition, higher comorbidity burden, hospitalization in the one-year preceding index admission, frailty, delirium, as well as functional decline and poor oral intake during the index admission, were more commonly observed among patients who were readmitted within 30 days of discharge (P < 0.05). Patients with active depressive symptoms were significantly more likely to be frail (OR = 1.62, 95% CI 1.22-2.16), had poor oral intake (OR = 1.35, 95% CI 1.02-1.79) and functional decline during admission (OR = 1.58, 95% CI 1.11-2.23). Malnutrition at admission was significantly associated with frailty (OR = 1.53, 95% CI 1.07-2.19), delirium (OR = 2.33, 95% CI 1.60-3.39) cognitive impairment (OR = 1.88, 95% CI 1.39-2.54) and poor oral intake during hospitalization (OR = 2.70, 95% CI 2.01-3.64). In minimal adjustment set identified by DAG, depressive symptoms (OR = 1.38, 95% CI 1.02-1.86) remained significantly associated with 30-day readmission. The association of malnutrition with 30-day readmission was no longer statistically significant after adjusting for age, ethnicity and depressive symptoms in the minimal adjustment set (OR = 1.40, 95% CI 0.99-1.98). CONCLUSION The observed causal associations support screening and targeted interventions for depressive symptoms and malnutrition during admission and in the post-acute period.
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Affiliation(s)
- Tay Laura
- Department of General Medicine, Sengkang General Hospital, 110 Sengkang East Way, 544886, Singapore, Singapore. .,Geriatric Education and Research Institute, Singapore, Singapore.
| | - Chua Melvin
- Department of General Medicine, Sengkang General Hospital, 110 Sengkang East Way, 544886, Singapore, Singapore
| | - Ding Yew Yoong
- Geriatric Education and Research Institute, Singapore, Singapore.,Department of Geriatric Medicine, Tan Tock Seng Hospital, Singapore, Singapore
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